UPDATE:

Per the Red Wings’ twitter feed, Helm had surgery to repair lacerated tendons in his right forearm. He’s done for the season

After just having missed a few weeks with a sprained knee, Red Wings’ center Darren Helm caught a tough break in last night’s series opener against the Preds. A hit on Alexander Radulov along the boards resulted in what appeared to be Helm’s right wrist coming down hard on one of Radulov’s skate blades. There are a lot of possibilities for what sort of injury Helm might have, with a lot of possible outcomes with respect to his ability to continue on in the playoffs.

With the playoffs upon us, teams are well into lockdown mode as concerns injuries, and are disclosing the absolute minimum. All league policy requires is whether the player will return to the game in which they were hurt, if they’re expected to miss games, and frankly not much more. Teams are prohibited from misrepresenting a player’s condition, hence the vague yet apparently adequate upper body/lower body injury. Darren Helm’s upper body injury last night had the dubious distinction of being caught on tape, and thus a bit easier to speculate about.

 

 

Helm kept playing for a second, then looked down at the injured wrist and made a sprint for the bench. What’s interesting is that he carried his stick most of the way to the bench in his right hand – the injured one. That combined with the fact that he didn’t immediately realize he was hurt might be a glimmer of good news in what could easily be a serious injury.

 

What’s in a wrist?

Unfortunately a lot of really important stuff, and it’s all pretty close to the surface. Consider that at the end of your arm lies your hand, and the two are connected by the wrist. The hand is complicated enough that you can’t just go to medical school, do a surgical residency and operate on that sucker. You have to do all kinds of extra fellowship training just to get a crack at it. Because it’s COMPLICATED. And all the stuff that  runs the hand? Well, that runs through the wrist.

 

Bones are circled (just in case you missed them)

 

The wrist has 8 little bones that don’t really like being messed with. Remember when Patrick Kane broke his wrist at the end of last season and had to have surgery on it? Exactly. He messed up one of those bones, and it didn’t like it.

 

This is why there's a fellowship for hands.

 

Ligaments. Oh man, ligaments. The wrist is crammed full of ligaments because it’s COMPLICATED and has so many bones. You have to connect the bones of the hand/fingers to the wrist and then to the arm, and for that you need ligaments. Lots and lots of ligaments. It’s not hard to imagine that cutting any of these would affect wrist function and stability, and probably land you in an operating room with one of those hand experts.

 

I like to call this "the fleshy bits"

 

In addition to all the bones and ligaments, the wrist has two arteries – radial (where you check your pulse) and ulnar. There’s also a whole bunch of tendons – the extensors on the back of the wrist, whose job it is to extend your fingers, and all the ones that run through the middle of the wrist responsible for flexing things. The wrist also carries the nerves responsible for movement and sensation in the hand.

 

What happened to Helm’s wrist?

The obvious answer is that he cut it. The not-so-obvious part is what exactly he cut in there. The possibilities:

- Just the skin: This is the best possible outcome. If all he did was slice a little skin, he can be stitched up and probably be ready to play in the next game. You or I might take a little time off, rest the wrist, not run the risk of popping a stitch, but you and I aren’t NHL players, and you and I aren’t in the playoffs.

- An artery: This is not fantastic. Obviously. It’s also not the end of the world. The beauty of the blood supply to the hand is that if you lose one artery, the other can usually take over. Unfortunately this is probably after you’ve already gone to the OR with the hand expert (after having also bled a whole bunch). An arterial bleed here looks really impressive, but it happens more often than you’d think and the outcome is usually good. Related to that, the following items should be banned around clumsy and/or drunk people: Glass coffee tables, fish tanks, sliding glass doors.

- A nerve: How bad this is depends on what nerve is affected, and how badly. Losing feeling in part of your hand sucks, but may not be a career ender. Losing the ability to actually move your hand? Probably a career ender. Nerves can be repaired (sometimes) but the rehab isn’t on a timetable that would allow a return to the playoffs.

- Tendons: Again, you’ve got two basic types of tendons. The flexors (which allow you to grip things) and the extensors (which allow you to let go of things). When you come to the ER with a wrist laceration, they’re going to run you through a super fun series of movement tests to determine if you’ve cut any of your tendons. Can you move your thumb? Can you flex and extend your fingers? Now remember how I pointed out that Helm held his stick in his injured hand? I’m going to assume that means he can grip with that hand. So he may not have cut any of the tendons (the flexors, anyway). That’s not a completely safe bet, though. Let’s not forget Ottawa goalie Craig Anderson cut one tendon in his little finger while making some delicious chicken and ended up unable to hold his stick. Again, just a reminder – hands are COMPLICATED.

If Helm has cut one or more tendons in his wrist, it’ll affect his hand function, and he’ll need a surgical repair. While ER doctors can repair tendons, I’m guessing if you’re an NHL player they’ll probably get the hand guy or gal for you. That’s going to be more than just a couple of hours in the ER, and somewhere in the neighbourhood of 6-8 weeks of recovery.

- Any combination of the above: This is a likely scenario. All of that important stuff in the wrist (hand, forearm) is in more or less the same place. If you cut one thing, you’ve probably cut several things. Mike Modano had a similar injury last year when he was cut by RJ Umberger’s skate – he had tendon and nerve damage, and ended up missing half the season because of it. The biggest difference between these two is clearly age. Modano was 40, Helm is 25. Nothing against the long-lived speedo-sporting Modano, but younger people heal faster. That’s just how it goes.

 

The take-home

Helm went to Vanderbilt to be evaluated after his injury, and ended up in surgery – but for what, we don’t know yet. The good news is Vandy has hand experts, and even a hand fellowship. The bad news is Helm may have ended up needing them. Lacerations in sensitive areas like the wrist can run the gamut from a simple suture repair to something needing multiple orthopedic and/or neurosurgical repairs. My hope is that Helm’s seeming ability to use his hand after his injury means that he’s not compromised his function too badly. The reality is that there’s really no way to know that from a video. We won’t know what’s going on in there until there’s an update on what surgery was required, and my guess is we won’t even be getting that. All we’ll get is “yes, he’ll be back”, “no, he won’t be back”, or my favourite – “he’s day to day”.

Comments (3)

  1. I wince so often during your posts

    • Me too, but that’s what makes them so good. No punches pulled, no sugarcoating, no dodging the gruesome or uncomfortable, just truthful and accurate explanation.

  2. Could he maybe have cut the extensor tendons and that’s why he was unable to drop his stick once he realized something was wrong?

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